Beta-Adrenergic Blocker (Ophthalmic)

Beta-adrenergic blockers are used to treat certain types of glaucoma by lowering the pressure in the eye.

Overview

Beta-adrenergic blocking agents are used for the treatment of glaucoma. This class of medicines, also known as beta blockers, are used to block the production of substances such as adrenaline. In doing so, these beta blockers prevent some of the autonomic nervous system actions with the effect of relaxing blood vessel contraction throughout the body.

Beta-adrenergic blockers reduce intraocular pressure (the pressure within the eye). It is not known precisely how this occurs but it is thought that the production of aqueous humor (the liquid within the eye) is reduced. With this reduction the internal pressure on the eyeball is relieved.

Beta-adrenergic blockers are used to reduce pressure and in doing so prevent damage of the optic nerve and the resultant loss of vision in patients suffering from glaucoma.

This form of beta-adrenergic blocker is taken in the form of eye drops.

These medicines come in a number of forms including:

  • Betagan
  • Betimol
  • Betoptic S
  • Istalol
  • Ocupress
  • Optipranolol
  • Timoptic Ocudose
  • Timoptic Ocumeter
  • Timoptic Ocumeter Plus
  • Timoptic-XE Ocumeter
  • Timoptic-XE Ocumeter Plus

These medications are available only with a doctor's prescription.

Condition treated

  • Glaucoma, certain types of

Type of medicine

  • Beta-adrenergic blocking agents

Side Effects

In addition to lowering the pressure in your eyes, ophthalmic beta-adrenergic blocking agents can have unwanted side effects. Not all of the effects listed herein may occur, but if they do then they may require medical attention. In the case of symptoms of overdose emergency medical treatment may be required.

If you experience any of the following side effects then you should inform your doctor at the earliest possible convenience.

Occurring commonly

  • Redness of eyes
  • Redness of the inside the eyelids

Less common or rare

  • Blurred vision or other changes in vision
  • Different size pupils in each of your eyes
  • Discoloration of the eyeball being treated
  • Droopy upper eyelid
  • Eye pain
  • Redness or irritation of the tongue and/or inside of the mouth
  • Seeing double
  • Swelling, soreness or inflammation of the eye and/or the eyelid

Other side effects can occur that may not need medical attention. These can abate over time as your body develops a tolerance to the treatment. In most cases, these side effects will not need to be treated by a doctor, but if they become bothersome or are ongoing then inform your doctor and they may be able to help to alleviate the symptoms.

Occurring commonly

  • Blurred vision which lasts for only a short period of time
  • Decreased ability to see in the dark
  • Stinging of eye or other eye irritation at the point of application

Occurring less commonly or rarely

  • Acid stomach
  • Belching
  • Browache
  • Constipation
  • Crusting of eyelashes
  • Dryness of eye
  • Dry skin
  • Feeling of something in the eye
  • Increased sensitivity of eye to light
  • Indigestion
  • Itching, stinging, burning, watering or other irritation in the eye
  • Pain in the muscles. Swelling and redness can also occur

Absorbing too much of this class of medication into the body can affect other areas of your health. The following symptoms can show that you are absorbing too much of the medication and overdosing. If any of the following symptoms of overdose are experienced you should seek emergency medical attention:

  • Ankle, knee, or big toe pain
  • Ankle, knee, or big toe swelling
  • Anxiousness or nervousness
  • Bloody or cloudy urine stream
  • Breast pain
  • Burning or prickling feeling on skin
  • Change in taste
  • Chest pains
  • Chills
  • Clumsiness or unsteadiness on feet
  • Confusion or mental depression
  • Coughing, wheezing, or difficult breathing
  • Decreased sexual ability
  • Decreased sexual desire
  • Diarrhea
  • Difficult, burning, or painful urine streams
  • Dizziness or faintness
  • Drowsiness
  • Dryness or soreness of throat
  • Ear pain
  • Feeling of constant movement or feeling that surroundings are moving
  • Fever
  • Hair loss
  • Hallucinations
  • Headache
  • Hoarseness
  • Irregular heartbeat
  • Lightheadedness
  • Lower back or side pains
  • Muscle or joint aches or pains
  • Muscle tightness or stiffness
  • Nausea or vomiting
  • Raw, blistering or crusty areas of the skin
  • Ringing or buzzing in the ears
  • Runny, stuffy, or bleeding nasal passage
  • Skin rash, hives, or itching
  • Swelling in the feet, ankles, or lower legs
  • Troubled sleep
  • Unusual tiredness
  • Unusual weakness

Dosage

To use ophthalmic beta-adrenergic blockers follow the following steps.

  • Ensure face and hands are cleaned thoroughly.
  • Use middle finger to apply pressure to the inside corner of the eye. This pressure should be maintained for 2 minutes after the medicine has been placed in the eye.
  • Tilt the face back and use the forefinger to gently pull the lower eyelid down.
  • Drop the medicine into the opening and close the eye for 2 minutes while still maintaining pressure in the inside corner of the eye. This allows the medicine to be properly absorbed into the eye.
  • Clean your hands thoroughly once again to ensure all medicine is removed.

Some of the beta-adrenergic blocker applicators have specific instructions that need to be followed for the use of the individual drops. Where this is the case you should follow the manufacturer instructions and listen to the instruction given to you by your doctor. These individual requirements may include shaking thoroughly or twisting the cap to see the date of the next dose.

If you wear contact lenses then they need to be removed before the eye drops are used. Keep them out of the eye for a further 15 minutes after using the medicine. This is particularly important with soft lenses as these may be dissolved by the eye drops, causing significant problems.

The dose of this medicine will be different for different patients and will depend on the strength of the different beta-adrenergic blocker that you are using. The following is merely a guideline and you should follow the dosage that your doctor gives to you when you receive the prescription.

Betaxolol, carteolol and metipranolol:

  • Adults - One drop twice a day.
  • Infants - To be determined by the doctor.

Levobetaxolol

  • Adults - One drop twice a day.
  • Infants - To be determined by the doctor.

Levobunolol and timolol

  • Adults - One drop once or twice a day.
  • Infants - To be determined by the doctor.

Use of this medicine should only be carried out only as instructed. Do not take more than you are directed to. Taking too much of this medication can lead to more serious side effects being experienced.

If you miss a dose then you should take the dose as soon as possible. If, however, it is close to the prescribed time for your next dose then you should skip it. Return to your usual schedule after the missed dose. Never take a double dose of this medication.

Interactions

Certain medicines should not be used in conjunction with one another. In some cases, drugs can interact with one another to stop one or other from having the desired effect or they can worsen the side effects experienced. In such cases, it may be necessary for your doctor to change the medicines you are being prescribed or to change the dosage of one or other of the medicines that you are receiving. Inform your doctor of all medications that you are taking so they can prescribe the correct treatment.

Using Beta-adrenergic blockers with any of the following medicines would not normally be recommended. Your doctor may still prescribe both.

  • Clonidine
  • Diltiazem
  • Epinephrine
  • Fingolimod
  • Verapamil

Medication can sometimes react differently when you have other existing medical conditions. It is important that you tell your doctor about any medical conditions that you have or have had in the past. When taking beta-adrenergic blockers it is especially important that you inform your doctor of any of the following conditions:

  • Severe allergic reactions

This class of medication can reduce the effectiveness of medicines that are used to treat severe allergic reactions. If you are prone to anaphylaxis then this medication could put you at more serious risk of death.

  • Asthma, lung disease, chronic bronchitis or emphysema

Breathing problems of a severe nature including death have been reported in some patients after use of Beta-adrenergic blockers. While such occurrences are rare, there is a risk of troubled breathing and wheezing when taking this medication. Caution should be taken when dealing with people who have a history of breathing troubles.

  • Type 2 diabetes mellitus

  • Hypoglycaemia

Beta-adrenergic blockers can cause side effects that may cover up signs of hypoglycaemia. While signs such as dizziness or sweating will still indicate the problem, caution should be exercised.

  • Heart of blood vessel disease

Heart activity may be decreased by the use of beta-adrenergic blockers.

  • Overactive thyroid

Ophthalmic route Beta-adrenergic blockers can cover up symptoms of hyperthyroidism in the patient. Cessation of the use of ophthalmic Beta-adrenergic blockers can also cause sudden and dangerous increases in overactive thyroid symptoms.

Warnings

Before taking any medicines it is important to understand the effect that they may have on your body. Medicines can have unwanted side effects as well as the desired effects and they can react to other substances in your body. It is vital that you inform your doctor of any and all medications or substances that you are taking and of any medical conditions that you have before taking this treatment.

Before taking beta-adrenergic blockers you and your doctor should consider the following to assess the risks of using these group of medicines and weigh them against the positives of the treatment:

Allergies - Your doctor will need to know if you have ever had any allergic reaction to any Beta-adrenergic blocking agents in the past. Allergies to dyes, preservatives, animals, other medicines and other substances are also important to share.

Age - Both the elderly and infants will be more sensitive to the effects of ophthalmic Beta-adrenergic blockers. This can make the side effects of the treatment more severe in both infants and the elderly. This does not prohibit use, but should be considered when accepting a prescription.

Pregnancy - Ophthalmic Beta-adrenergic blockers can be absorbed into the body. While these medicines have not been studied in pregnant women, animal tests including tests on both rabbits and rats have shown that several of them can cause embryo birth defects. The following Beta-adrenergic blockers have all been shown to cause birth defects through animal testing:

  • Levobetaxolol
  • Carteolol

Other beta-adrenergic blocking agents have not been shown to cause birth defects, but studies have shown a great chance of death of the animal fetus when using Beta-adrenergic blocking agents. Before using any ophthalmic Beta-adrenergic blockers, ensure you have informed your doctor if you are either pregnant or may become pregnant during treatment.

Breastfeeding - Some beta-adrenergic blockers have been shown to pass into breast milk when taken orally. It is unknown whether ophthalmic beta-adrenergic blocking agents may also pass into the milk, but it is known that they may be absorbed into the body. While these medicines have not been reported to have caused complications in babies nursing from a recipient of ophthalmic Beta-adrenergic blockers, you should consider the possible risks and weigh them against the benefits of breastfeeding whilst taking this medication.

When taking this class of medications you should be regularly examined by your doctor. They will need to check the pressure in your eye over regular intervals to ensure that the glaucoma is being properly controlled and that no other unwanted side effects are occurring. Ensure that you are able to see your doctor regularly for these check-ups.

You should consult with your doctor before undergoing any kind of eye surgery.

If you experience any kind of eye trauma you should also contact your doctor and if you suspect that an infection is occurring in your eye then you should consult your doctor too. In cases of infection, you may need to cease use of the Beta-adrenergic blocking agent.

When you use this treatment your vision may be blurred for a short period of time. It is important that you allow this to pass before attempting to drive, operate machinery or do anything that could put you or another person in danger if your vision were to be impaired.

If you are undergoing any dental surgery or any emergency medical treatment, inform the doctor that you are using this treatment. The use of ophthalmic Beta-adrenergic blocking agents can increase the side effects of surgeries.

Warning for diabetic patients:- Ophthalmic beta-adrenergic blockers can affect the amount of sugar in your blood and can also cover up symptoms of hypoglycaemia. Signs that may be missed include trembling or an increase in heart rate. Other signs including dizziness and sweating, will however not be affected. When taking this medication you should be alert to these signs and should inform your doctor if you realise a change in blood sugar levels is occurring.

Beta-adrenergic blockers can cause the eye to become more sensitive to light. The discomfort caused by this can be counteracted with the use of sunglasses to reduce the exposure to light.

Storage

Keep medicine out of reach of children at all times.

Store the medicine in its original sealed container at room temperature.

Keep out of direct light and keep away from heat and moisture. Prevent from freezing.

Do not keep outdated medicine. Seek advice from a healthcare professional for proper disposal guidelines.

Ensure Levobetaxolol is stored upright at all times.

Summary

Ophthalmic beta-adrenergic blockers are used for the treatment of some forms of glaucoma in both adults and older children. The beta-adrenergic blockers work in the body by preventing some autonomic nervous system actions. In the eyes this reduces the pressure of the aqueous humor within the eye. It is not known precisely how this occurs but the pressure is thought to be relieved by reducing the production of liquid in the eye.

If untreated glaucoma can cause damage to the optical nerve and can eventually result in sight deterioration and loss. This treatment is not a cure for glaucoma, but it will relieve the pressure on the eye to reduce its impact.

There are numerous available treatments that use ophthalmic beta-adrenergic blockers for the relief of glaucoma. These eye-drops are administered in different doses and the instructions given by your doctor should be followed.

It is important that you inform your doctor of any and all medications that you might be taking when you are prescribed with beta-adrenergic blockers. In some cases, one or other medication may need to be changed to avoid interaction.

This medication should also be avoided when suffering from certain medical conditions. Ensure that you have informed your doctor of all of the medications you are taking and all of the medical conditions that you may have or have had in the past.

You should also seriously consider the use of this medication when pregnant or trying to get pregnant. Animal studies have shown that harm can be done to a fetus when large doses of this medication are administered. Consider the potential risks with your doctor before taking this medication when pregnant.

Typically the eye drops used for ophthalmic administration of beta-adrenergic blockers with be used at the same time daily. Ensure that your hands and face are clean before application and always avoid making contact between the applicator and your eye or any other surfaces.

If you wear contact lenses then they should be removed before application of the treatment. Keep them clear of the eye for 15 minutes after treatment. This is particularly important if you use soft lenses which can be caused to disintegrate by the drops.

Absorbing too much of this medication into the body can have serious consequences. If you notice any signs of overdose then you should seek emergency medical attention.

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Last Reviewed:
December 22, 2017
Last Updated:
April 04, 2018
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